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      Adrienne Stauder MD, PhD, psychiatrist, psychotherapist
Institute of Behavioural Sciences, Semmelweis University Budapest
Hans Selye Hungarian Society of Behavioural Scienes and Medicine

What is stress?

Hans Selye (1907-1982, Hungarian born Scientist, works in Canada
Introduces the term „stress” into everyday language
His stress theory: the General Adaptation Syndrome (GADS):
„The state manifested by a specific syndrome which consists of all the
non-specifically induced changes within a biological system”
The three phases of GADS:
                             1.Alarm reaction,
                             2. Resistance phase
                             3. Exhaustion phase
The third is the most harmful, a consequence of chronic stress!
(„Vital exhaustion”)

In widest sense: in the process of interrelationship between person
and his/her environment those situations which need new behavioural

Harmful or protective?     Selye: eustress and distress

Evolutionary model of stress:
Stress responses act as triggers for the adaptive modification of the
structure and the function of the brain.
Stress responses serve to adjust in the physical, emotional and
personality development in a self-optimising manner, in accordance
with the ever-changing requirements of the external world.

Canon alarm reaction: the fight or flight reaction
Modern stress concept: the cognitive activation theory
Stimulus: Stressor, perception
Processing : filtering, appraisal, comparison, decision
Physiological, emotional reactions - coping
Coping: planned behaviour to adapt to the situation

Acute severe stress: life-events //// chronic stress
Work-stress is a more important for men
Marital stress is more important for women
Stress can cause disease, and chronic stress is a stressor

•emotional ways of coping

•problem solving ways of coping

•support seeking

Real coping ability /// perceived coping ability
The importance of positive psychology:
•Learned resourcefulness: (Mihály Csikszentmihályi:Flow)

•The experience of the controllability of stress situations

•The ability to deal successfully with stressors strengthens the self-

esteem, self-efficacy and the problem solving, coping skills of the

EQ: Emotional intelligence (more important than IQ?)
Mayer and Salovey, from the 1990ies
Goleman: Social succesfulness
Ability to identify, understand and express own feelings, and feelings
of others       (unable: alexithymia, Sifneos 1970is)
Ability to use feeling

The health consequences of psychosocial distress

Psychosomatic symptoms
Psychiatric disorders (anxiety, depression, post-traumatic stress d.)
Employed workers die more frequently on Monday (AMI, CHD)
People with higher education and socio-economic status live longer
Immun dysfunctions (tumor in widows, common cold in exam periode)

High prevalence of premature mortality especially for 45-60 years old

men is a major health issue in Hungary. Chronic stress due to rapid
political and economical changes: challenge for adaptation and coping
Behavioural medicine:what interventions can help?

Need for intervention, especially in high risk groups
Social support, building helping networks
Improve stress management: Evidence based, cost effective,
structured, easy to distribute interventions

Community based programs- small group format

Complex programs:
Identification of stressors and emotional reactions
Appraisal - cognitive restructuring
Relaxation techniques (both physical and psychological tension)
Problem solving (e.g. time management, cooperation)
Communication techniques eg. assertiveness, active listening,
speaking about self (interpersonal conflicts, social support)
Empathy (understanding others pperspectives ad reacctions)
Emphasizing positives, humor
Pleasureble activities, physical activities, hobbies
Special issues: Life-style, disease management

The Williams Life Skills program

16 hours, structured, small group intervention

Effectiveness: Decreased perceived stress, anxiety, depression,
hostility scores
In CHD patients decreased resting blood pressure and heart rate
In streesful situations, smaller increase in systolic blood pressure
What are the effects of the program in high distress and healthy
I. Methods.

Statistics: Paired Sample test pre / post intervention
High distress / psychosomatic group N=21
     Psychosomatic Out-patient Clinic, internet
3 workshops, 28 participants
6 dropped out (21%), 1 no pre-intervention questionnaire
21 participants in data analyses
   14 women/ 7 men, mean age: 31,8±8,7 ys (range 21-53)

Students in medicine or psychology N=18
 2 workshops, 21 participants
 1 dropped out (5%), 1 no pre- 1 no post- intervention questionnaire
18 participants in data analyses
   14 women/ 4 men, mean age: 24,7±4,3 ys (range)


•PSS14 Perceived Stress Scale (Cohen et al, 1983)
•STAI-T Spielberger Trait Anxiety (1970)
•BDI  Beck Depression Inventory, shortened (1961)
•HOST   Cook-Medley Hostility, shortened (1954)
•PHQ15   Patients Health Questionnaire /PRIME MD              somatic
symptoms subscale (Kroenke 2002)

•Life Meaning Stress and coping ss Rahe, Tolles (2002)
•WHO      WHO Well-Being, 5 item, Bech et al. (1996)
•Satisfaction overall, how satisfied with your life? (1-10)

•Happiness   overall, how happy do you feel? (1-10)
What are the effects of the program in high distress and healthy
II. Results by objective measures.

High distress group: indices of distress significantly decreased on all
scales and the means approached the normal range. There was a
great decrease in PSS14, STAI-T, BDI, and a smaller on PHQ and
hostility scores.
Student group: indices of distress decreased, significantly for STAIT
and BDI and nearly significant (p=0,08) for PSS14.

High distress group: indices of well-being significant increased
meaning in their life, they felt more satisfied and happier.
Student group: Positive changes could be also observed in students,
that was significant for WHO, Life meaning, satisfaction and

III. Subjective evaluation of the Williams Life Skills program
Scores 1-5 (not at all – very much) students / high distress groups

•Satisfaction with the program: 4,06 / 4,35
•Satisfaction with Facilitator(s): 4,41 / 4,72

•Usefulness of the Workbook: 4,41 / 4,76

•Usefulness of other materials: 4,20 / 4,44

•Can use in my private life: 4,12 / 4,33

•Can use in my work: 4,29 / 4,24

Would you recommand the program to others?

33 yes / 3 maybe        /   0 no
IV. Specific benefits of the stress management program

•General feedback:
„I became more courageous.”
„I’m glad that these are not such complicated techniques. It is
something simple, but connects well to the complexity of life.”
„By applying these skills, I managed to solve the problems I brought
into and presented in the group.”

•Relationship with partner:
      •„I am assertive with my ex-husband.”

      „When negotiating issues related to my divorce in a tense
atmosphere, I could acknowledge the perspectives of my husband,
and I tried to include positives among the negatives I said. I dared
making concessions, and this allowed me to better represent the
issues of special importance to me. We could reach an agreement
without having fierce quarrels or being overwhelmed by negative

Parent –children relationships:
      „I managed to prevent arguments with my parents by using
cognitive restructuring and active listening skills.”
      „I noticed changes in my relationship with my mother. Our
relationship has improved since I use empathy, active listening, and
speaking up.”
      „I managed to ease down the persistent problem with my teen by
empathy and speaking up.”

Applying life skills at work:
     „For my problems at work I use cognitive restructuring, thus I try
to avoid bringing home my work related problems.”
     „I noticed that I am more patient with my patients, I don’t lose my
temper so easily.”
     „I am more successful in getting round the nervous, impatient,
and agressive patients.”
     „I managed to encourage a new colleague who had difficulties in
adapting himself to our team.”

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